A Ray of Hope in Desperation
In the early hours of a deep winter day in 2023, 3-year-old Xiaoyu curled up on a stretcher in the emergency hall of Beijing Jingdu Children's Hospital. His abdominal circumference had reached 68 centimeters—1.8 times that of a child of the same age. His skin was stretched tight and shiny, with cyan blood vessels coiled like vines. When his parents rushed into the consulting room with their last glimmer of hope, the mother's down jacket was still covered with ice chips from the overnight journey, and the father's phone stored the CT report from the local hospital: hepatoblastoma, 11.2 centimeters in diameter, invading the left branch of the portal vein with tumor thrombus formation.
"The tumor has occupied 70% of the liver volume, compressing the inferior vena cava and causing lower limb edema," said Director Duan Weihong, who received them, pointing to the three-dimensional reconstruction image urgently produced by the imaging department. The red tumor area on the liver lobe model was shocking. "The risk of ordinary surgical resection exceeds 80%, but we have experience in treating children with Child-Pugh Class C." This sentence made the parents, who were on the verge of collapse, suddenly freeze—it was the first time they had heard the words "have experience" after visiting 5 hospitals.
Precise Deployment and Race Against Time
A multidisciplinary consultation was urgently launched within two hours. The anesthesiology department calculated that Xiaoyu's maximum tolerable blood loss must not exceed 400 milliliters (only 1/5 of the adult safety threshold); the imaging department reconstructed the three-dimensional relationship between the tumor and intrahepatic blood vessels through 64-slice spiral CT, marking 3 hepatic segment arteries that must be preserved; the hematology department prepared 10 units of suspended red blood cells and 800ml of fresh frozen plasma—equivalent to 1.2 times the total blood volume of this 15-kilogram child.
The surgical plan was finally finalized as "ex vivo liver tumor resection + autologous liver transplantation", which is a top-level technology in pediatric liver surgery, and no more than 5 medical institutions in China can carry it out. Director Duan Weihong drew the surgical flowchart on the whiteboard: first, dissect the liver until only the hepatic pedicle is connected, resect the tumor-containing liver segment under hypothermic perfusion, then trim the remaining 30% of healthy liver tissue and reimplant it. The entire process must be completed within 4 hours, otherwise the remaining hepatocytes will die due to ischemia.
On the day of the surgery, when the anesthesiologist injected propofol, Xiaoyu suddenly grabbed the nurse's hand and stuffed the Ultraman card he had been clutching all the way into her pocket: "Sister, keep it for me. I'll come back to get it after defeating the monster." On the monitor, his heart rate suddenly rose to 140 beats per minute, while his blood oxygen saturation dropped to 92%. The anesthesiology team immediately added 0.5μg/kg of fentanyl to calm the overstressed little one.
A Dance on the Tip of a Knife
At 9:17 a.m., the surgery officially began. When the laparoscope lens was inserted into the abdominal cavity, the tumor on the screen looked like a rotten fruit, forming dense adhesions with the stomach wall and transverse mesocolon. When Director Duan Weihong separated with an ultrasonic scalpel, the monitor suddenly gave a sharp alarm—the portal vein pressure soared to 32cmH₂O in an instant, 3 times that of a normal child. "Prepare to block the first hepatic portal!" As soon as he finished speaking, the assistant handed over a specially made miniature atraumatic vascular clamp.
The most dangerous moment came when removing the tumor thrombus. When dissecting the 2.3-centimeter-long cancer thrombus in the left branch of the portal vein, a stream of blood suddenly sprayed from the blood vessel break. The blood pressure dropped from 90/60mmHg to 58/32mmHg within 15 seconds. Director Duan Weihong pressed the bleeding point precisely with his left index finger and completed 3 sutures with 7-0 prolene thread in his right hand, the entire process taking only 47 seconds. The instrument nurse later said that the blood beads on the surgical forceps hadn't had time to drip before the suture was completed.
At 13:02, when the trimmed liver tissue was reimplanted into the abdominal cavity, the moment the portal vein was opened, pale red blood flowed into the liver, and the originally pale liver tissue turned red within 30 seconds. "Residual liver volume is 187ml, which meets the standard!" The value reported by the instrument nurse made the tense air in the operating room finally flow—this number meant that the liver could maintain basic metabolic functions.
The Road to Rebirth and a Tribute to Life
On the 3rd day after the operation, Xiaoyu's total bilirubin soared to 342μmol/L (10 times the upper normal limit), entering the dangerous period of liver failure. The PICU nurse recorded the bile drainage volume every hour. When the value was less than 10ml for 8 consecutive hours, Director Duan Weihong decided to use continuous renal replacement therapy (CRRT) and perform plasma exchange with a child-specific pipeline.
A turning point occurred in the early morning of the 7th day after the operation. The nurse found that the bile in the drainage bag suddenly turned golden yellow, with a volume of 56ml. She took a photo and sent it to the doctor-patient group. When Xiaoyu's mother saw the message in her hometown, she was washing the small socks her son wore before the operation, and tears fell on the washboard. The liver function report that day showed: albumin increased from 21g/L to 32g/L, and prothrombin time decreased from 28 seconds to 14 seconds.
On the day of discharge, Xiaoyu stood on the weight scale in new clothes: 16.5 kilograms, 1.5 kilograms heavier than when he was admitted. He ran to Director Duan holding the re-examination ultrasound report, on which the words "no obvious space-occupying lesions" were shining in the sun. At the moment when the mother suddenly knelt down to present a hada, Director Duan Weihong quickly held her. A half notebook recording 23 medication adjustments was exposed from his white coat pocket—17 of which were marked "adjust sedative dose according to the child's nighttime crying degree".
Now, Xiaoyu's follow-up record stays at 18 months after the operation, and the latest alpha-fetoprotein value is 3.2ng/ml (normal range 0-7ng/ml). During each video follow-up, he always holds up his kindergarten painting: in the picture, there is a person in a white coat holding a scalpel brighter than a star, with the magnolia tree in front of the outpatient building of Jingdu Children's Hospital in the background—it was in full bloom when he was discharged.
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